Modern Laparoscopic Surgery

Laparoscopic surgery, sometimes called minimally invasive surgery (MLS), keyhole surgery, or band aid surgery, refers to surgical procedures performed in the abdomen through several small incisions (roughly a quarter to a half inch in length) rather than the one larger incision (typically 6-8 inches in length) used in traditional operative techniques.

In order to perform a laparoscopic procedure, the surgeon needs to make several incisions at various points on the abdomen to insert a miniaturized television/video camera that transmits a magnified image to a television screen, a source of cold light, miniaturized surgical tools, and a tube that blows carbon dioxide (CO₂) into the abdomen to lift and separate the body tissues so the surgeon can properly view the surgical area and perform the procedure.

Laparoscopic procedures are part of a larger field of medicine known as endoscopy. Endoscopy refers to the use of specialized scopes and cameras to view the interior of the body and miniaturized tools to perform diagnostic and operative procedures. Development of a computer chip television camera in the early 1980s provided a way to project a magnified image of the operative field onto a monitor (screen) that the surgeon could readily view. It also freed both of the surgeon’s hands to enable the surgeon to better perform complex procedures.

Laparoscopic procedures for bariatric surgery are becoming increasingly common. Gastric banding is typically performed via laparoscopy. Sleeve gastrectomy, the newest weight loss surgery procedure, can also be performed laparoscopicaly. Laparoscopy is often used to perform Roux-en-Y gastric bypass procedure and, in some cases, laparoscopy is used to perform a biliopancreatic diversion procedure.

Advantages and Contra Indications

Although laparoscopic procedures result in less blood loss, tissue damage, shorter hospitalization, faster recovery, and fewer complications than traditional open incision surgeries, they are not right for every weight loss surgery patient. Patients who weigh more than 350 pounds carry most of their excess weight abdominally or who have scarring from previous abdominal surgery are often poor candidates for this procedure. Furthermore, it is more difficult to perform a combined weight loss surgery (one that involves restricting stomach size and bypassing portions of the intestinal tract) using laparoscopic techniques , and if done improperly, it can create serious problems that require additional surgery to correct.

If you are considering laparoscopic weight loss surgery, the National Institutes of Health suggests you locate a surgeon experienced in both open and laparoscopic procedures. Be sure to carefully and thoroughly investigate all weight loss options and surgical alternatives before proceeding with this life- and lifestyle-altering procedure.

Benefits of Laparoscopic Surgery

• Less blood loss, which decreases strain on the body to produce new blood and reduces the need for transfusions and the risks associated with them.
• Smaller incisions associated with laparoscopic procedures result in less scarring and reduce pain and recovery time.
• Quicker recovery and more rapid return to pre-surgical activity levels and work.
• Reduced risk of hernia.
• Reduced need for pain medications.
• Reduced internal exposure to external contaminants.
• Improved ability to suture incisions. This is especially important in very obese people as their excess weight makes it difficult to close and heal wounds.
• Decreased length of post-operative hospitalization. In some cases, people can go home the same day. This is particularly true after placement of a gastric band.
• Decreased hospital stay can help reduce cost of the procedures.

Risks of Laparoscopic Surgery

• The most significant risk associated with any form of endoscopic surgery, including laparoscopy, is injury of a blood vessel or the bowel with a trocar. A trocar is a slender hollow cylinder with a sharply pointed end that is used to introduce cannulas, laparoscopes, etc. into the body. The first trocar is inserted ‘blind’ since a camera needs to be placed to provide an interior view. The risk for trocar injuries are greatest in people who are obese or who have adhesions and scar tissue from prior abdominal surgeries.
• Electrical burns initially unnoticed by the doctor have occurred during some procedures. It these burns occur internally, they can damage organ tissue and lead to infections of the abdominal cavity.
• People with existing lung disease may have difficulty metabolizing and excreting all of the carbon dioxide used to inflate the abdomen and, thus, may not be candidates for laparoscopic procedures.
• Patients with blood clotting disorders have experienced complications while undergoing laparoscopic or other endoscopic surgeries. This may disqualify them for laparoscopic surgery.